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Urinary Incontinence: A Guide to Treatment

by Judy Hittman

Updated February 2013

Do you ever leak when you laugh or sneeze? Do you feel the constant urge to urinate, even when your bladder is empty? You may be one of the 10 million Americans with some form of urinary incontinence (the inability to control the bladder). Control can be greatly improved or completely restored with the proper treatment, so don’t be embarrassed to discuss it with your doctor.

Although urinary incontinence affects millions of people, and especially women, it isn’t inevitable. It’s a medical condition with many possible causes. You should seek treatment whenever changes in your bladder habits become noticeable, and it’s better not to wait until they interfere with your life. It may help to understand the basics before your visit to the doctor.

URINARY TRACT 101

Your urinary tract is a system for collecting, storing and expelling liquid waste (urine) from your body. The bladder has a 16-ounce capacity. When it becomes full it triggers the urge to get rid of the stored urine. Problems arise when the bladder wall is not strong enough to hold the urine or it contracts prematurely. Obstructions are another problem. In men, the prostate gland can sometimes pinch the flow of urine.

The Basics

Urinary Incontinence is the loss of bladder control.

Incontinence affect all ages, both sexes, and people of all races.

Although childbirth, menopause, and other experiences increase the risk of incontinence, incontinence is not inevitable for older people or women.

Incontinence can have many causes, so it is important to seek prompt treatment.

Qualified specialists include urologists, gynecologists, geriatricians, and physical therapists, but you will want to start with your family physician.

It may be helpful to keep a diary of your urinary habits, noting any changes such as blood in the urine, leakage, etc. in preparation for your doctor’s visit.

Bladder control can be greatly improved or completely restored with the proper treatment. Many of these treatments are free!

KINDS OF INCONTINENCE

Urinary incontinence ranges from occasionally leaking urine when you physically exert yourself (or cough, sneeze, or laugh) to having sudden, intense urges to urinate. There are several types:

Stress Incontinence: If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh, exercise, or lift a heavy object. For women, childbirth, some surgeries, and lower hormones from menopause can weaken the muscles under the bladder, and that allows urine to leak when the abdomen is under stress. In men, prostrate surgery can cause weakness.

Urge Incontinence (Overactive Bladder): If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have even a small amount of urine in your bladder. Most common in older adults, it is caused when the bladder suddenly contracts before the bladder is full. People feel an immediate urge to urinate and may lose large amounts of urine before making it to the restroom.

Mixed Incontinence: Mixed incontinence is a combination of urge and stress incontinence. It can cause a large volume of urine loss. The causes of the two forms may or may not be related and should be evaluated separately.

LESS COMMON FORMS OF INCONTENENCE

Overflow Incontinence: Most common in older men, this creates the urge to urinate due to a blockage, such as an enlarged prostrate, which prevents normal emptying. Nervous system disorders and spinal cord injuries can also cause overflow incontinence.

Other: Certain medications may cause lack of bladder control by relaxing muscles or by blocking signals sent from a full bladder to the brain. Urinary tract infections, constipation, dementia, and neurological problems can upset urinary control. Some medications may cause lack of bladder control by relaxing muscles or by blocking signals sent from a full bladder to the brain. In these instances, your doctor may change your medications to eliminate the side effects.

DIAGNOSIS

Stress incontinence is easy to diagnose, but some types of incontinence may require a specialist. Your primary care physician may refer you to a urologist, a surgeon who specializes in the urinary conditions of men and women, or a gynecologist. Older patients may be referred to a geriatrician, a doctor who specializes in treating the elderly.

Your doctor may ask you to keep a daily diary of when you urinate and when you leak urine. Your pattern of urinating and urine leakage may suggest which type of incontinence you have and what treatment is best. As a general rule, the simplest and safest treatments should be tried first. If your doctor suspects a neurological cause, other tests may be ordered.

TREATMENT

Bladder training: With bladder training you can change how your bladder stores and empties urine. By learning to resist the urge to urinate, you can lengthen the time between trips to the bathroom.

Kegel Exercises: The kegel muscles are the muscles on the pelvic floor which you use to stop the flow of urine. Often doctors suggest that you squeeze and hold these muscles several times a day to strengthen support. These exercises can be used for stress as well as urge incontinence. For men, they can also help prevent premature ejaculation. These exercises are more likely to be effective if done correctly, daily, and for at least 6 weeks. Unfortunately, many women and men try them a few times, get discouraged, and quickly give up.

Other Exercises and Biofeedback: Other simple exercises can help build the kegel muscles, and biofeedback devices can help a woman learn to exercise kegel muscles more effectively.

Medication: Some drugs prevent unwanted bladder contractions. Some relax muscles, helping the bladder to empty more fully during urination. Others tighten muscles in the bladder and urethra to cut down leakage. Vaginal estrogen cream may be helpful in women after menopause. Men with prostrate enlargement can also benefit from medication. Make sure to talk to your doctor about the benefits and side effects of using any of these medicines long-term.

Surgery: Surgery should NOT be considered unless other treatments have been tried and failed. Sometimes surgery can improve or cure incontinence if it is caused by a problem such as a change in the position of the bladder or blockage due to an enlarged prostate. However, bladder slings, mesh implants, and other surgical treatments for stress incontinence have very high complication rates and may cause serious damage, especially as the implanted device ages (and possibly deteriorates) inside your body.